Microvascular injury, inflammation, and coagulation play critical roles in the pathogenesis of acute lung injury (ALI). Plasma protein C levels are decreased in patients with acute lung injury and ...are associated with higher mortality and fewer ventilator-free days.
To test the efficacy of activated protein C (APC) as a therapy for patients with ALI.
Eligible subjects were critically ill patients who met the American/European consensus criteria for ALI. Patients with severe sepsis and an APACHE II score of 25 or more were excluded. Participants were randomized to receive APC (24 microg/kg/h for 96 h) or placebo in a double-blind fashion within 72 hours of the onset of ALI. The primary endpoint was ventilator-free days.
APC increased plasma protein C levels (P = 0.002) and decreased pulmonary dead space fraction (P = 0.02). However, there was no statistically significant difference between patients receiving placebo (n = 38) or APC (n = 37) in the number of ventilator-free days (median 25-75% interquartile range: 19 0-24 vs. 19 14-22, respectively; P = 0.78) or in 60-day mortality (5/38 vs. 5/37 patients, respectively; P = 1.0). There were no differences in the number of bleeding events between the two groups.
APC did not improve outcomes from ALI. The results of this trial do not support a large clinical trial of APC for ALI in the absence of severe sepsis and high disease severity.
Nanoporous adsorbents are a diverse category of solid-state materials that hold considerable promise for vehicular hydrogen storage. Although impressive storage capacities have been demonstrated for ...several materials, particularly at cryogenic temperatures, materials meeting all of the targets established by the U.S. Department of Energy have yet to be identified. In this Perspective, we provide an overview of the major known and proposed strategies for hydrogen adsorbents, with the aim of guiding ongoing research as well as future new storage concepts. The discussion of each strategy includes current relevant literature, strengths and weaknesses, and outstanding challenges that preclude implementation. We consider in particular metal-organic frameworks (MOFs), including surface area/volume tailoring, open metal sites, and the binding of multiple H
2
molecules to a single metal site. Two related classes of porous framework materials, covalent organic frameworks (COFs) and porous aromatic frameworks (PAFs), are also discussed, as are graphene and graphene oxide and doped porous carbons. We additionally introduce criteria for evaluating the merits of a particular materials design strategy. Computation has become an important tool in the discovery of new storage materials, and a brief introduction to the benefits and limitations of computational predictions of H
2
physisorption is therefore presented. Finally, considerations for the synthesis and characterization of hydrogen storage adsorbents are discussed.
We assess the strengths and weaknesses of strategies for creating nanoporous hydrogen storage sorbents.
A Sudden Loss Of Vision Siegel, Mark D.
Journal of the American Geriatrics Society,
August 2017, 2017-08-00, 20170801, Letnik:
65, Številka:
8
Journal Article
The Society of Radiologists in Ultrasound convened a panel of specialists from radiology, orthopedic surgery, and pathology to arrive at a consensus regarding the management of superficial ...soft-tissue masses imaged with US. The recommendations in this statement are based on analysis of current literature and common practice strategies. This statement reviews and illustrates the US features of common superficial soft-tissue lesions that may manifest as a soft-tissue mass and suggests guidelines for subsequent management.
OBJECTIVES:To determine the rates of psychiatric illness in next of kin following the death of a relative in a medical intensive care unit.
DESIGN:Cross-sectional survey.
SETTING:A university ...teaching hospital, New Haven, CT.
PATIENTS:Forty-one next of kin who had served as primary surrogate decision makers before the death of their loved one in the intensive care unit 3–12 months previously.
INTERVENTIONS:Structured Clinical Interviews for DSM-IV and the Inventory of Complicated Grief–Revised were used to determine prevalence of psychiatric illness. Formal questionnaires were used to evaluate key features of the intensive care unit experience. Bivariate statistics were used to identify factors associated with the presence of psychiatric illness.
MEASUREMENTS AND MAIN RESULTS:Following 107 patient deaths, 51 next of kin were successfully contacted and 41 (80%) agreed to study participation. Thirty-four percent (95% confidence interval, 20% to 51%) met criteria for at least one psychiatric illnessmajor depressive disorder (27%), generalized anxiety disorder (10%), panic disorder (10%), or complicated grief disorder (5%). Disorders were more common in spouses than other kinship relations (63% vs. 16%, p = .002), those experiencing additional stressors after the loss (53% vs. 21%, p = .03), those who said the patient was ill <5 yrs (45% vs. 8%, p = .03), and those who said the patient’s physician was not comforting (71% vs. 23%, p = .02).
CONCLUSIONS:In a cohort of bereaved next of kin of patients who died in the intensive care unit, we identified a high prevalence of psychiatric illness, particularly major depressive disorder. More work is needed to identify those at risk for psychiatric illness so that appropriate interventions may be targeted.
We report a comprehensive thermodynamic analysis of thermal oxidation−reduction cycles for producing hydrogen that use metal ferrites with the spinel structure (MFe2O4; M = Fe, Co, Ni, and Zn) as the ...redox material. Solution phases (both solid and liquid) were included in the calculations as well as the expected line compounds. Omitting solution phases, whose existence is experimentally well-documented, has a very significant impact upon the results of the calculations. Thermodynamic modeling of the three important material-related aspects of the process was performed, including synthesis of the ferrite materials from bulk oxides, thermal reduction at high temperatures, and reoxidation by reaction with steam. An experimental investigation of the Ni x Fe3−x O4 system was performed to provide compositional data for comparison to model predictions. The results indicate that the Fe/Ni ratio, thermal reduction reaction kinetics, and the specifics of the cooling process affect the composition of the synthesized material. In particular, the presence of oxygen in the atmosphere during the cooling period following calcination substantially alters the sample composition. Predicted compositions following thermal reduction indicate that the stabilities are Fe3O4 > CoFe2O4 ∼ NiFe2O4 > ZnFe2O4 and that the zinc-substituted ferrite is less desirable for solar hydrogen generation because of the high vapor pressure of zinc. Finally, modeling of the water oxidation step shows that efficient reoxidation to the original ferrite is thermodynamically feasible in all cases. We conclude that the temperature history and level of background O2 present will affect both the phase purity of the initially formed material and the stability of the composition over the course of thermal cycling.
Challenges in using cytokine data are limiting Coronavirus Disease 2019 (COVID-19) patient management and comparison among different disease contexts. We suggest mitigation strategies to improve the ...accuracy of cytokine data, as we learn from experience gained during the COVID-19 pandemic.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Imaging in the Intensive Care Unit Toy, Dennis; Siegel, Mark D; Rubinowitz, Ami N
Seminars in respiratory and critical care medicine,
12/2022, Letnik:
43, Številka:
6
Journal Article
Recenzirano
Radiology plays an important role in the management of the most seriously ill patients in the hospital. Over the years, continued advances in imaging technology have contributed to an improvement in ...patient care. However, even with such advances, the portable chest radiograph (CXR) remains one of the most commonly requested radiographic examinations. While they provide valuable information, CXRs remain relatively insensitive at revealing abnormalities and are often nonspecific. Chest computed tomography (CT) can display findings that are occult on CXR and is particularly useful at identifying and characterizing pleural effusions, detecting barotrauma including small pneumothoraces, distinguishing pneumonia from atelectasis, and revealing unsuspected or additional abnormalities which could result in increased morbidity and mortality if left untreated. CT pulmonary angiography is the modality of choice in the evaluation of pulmonary emboli which can complicate the hospital course of the ICU patient. This article will provide guidance for interpretation of CXR and thoracic CT images, discuss some of the invasive devices routinely used, and review the radiologic manifestations of common pathologic disease states encountered in ICU patients. In addition, imaging findings and complications of more specific clinical scenarios in which the incidence has increased in the ICU setting, such as patients who are immunocompromised, have interstitial lung disease, or COVID-19, will also be discussed. Communication between the radiologist and intensivist, particularly on complicated cases, is important to help increase diagnostic accuracy and leads to an improvement in the management of the most critically ill patients.
For the past decade, hospitals have focused on the inpatient management of hyperglycemia, particularly in the intensive care unit (ICU). Extensive observational data have shown a consistent, almost ...linear relationship between blood glucose levels in hospitalized patients and adverse clinical outcomes, even in patients without established diabetes.
1
It has never been entirely clear, however, whether glycemia serves as a mediator of these outcomes or merely as a marker of the sickest patients, who present with the well-known counterregulatory stress response to illness. Several early studies suggested a clinical benefit from strict glucose control during critical care but were weakened by . . .
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